Clarification of Question by
hcsimo-ga
on
20 Apr 2004 08:47 PDT
I am interested in a number for the Federal Medicaid program, but good
research by a state with sizeable Medicaid population could be
extrapolated and would be acceptable. A study that I attempted for a
state Medicaid HMO would have identified hospital admissions resulting
from patient noncompliance as the major expense from noncompliance and
unnecessary Emergency Room visits and Ambulance transport as the major
items for abuse. Patient fraud must be reported to the State when
uncovered and involves false reporting of equipment losses
(wheelchairs, oxygen equipment, etc, selling prescription drugs on the
street, lending ID cards to friends for services, etc. I have
personally looked for such studies and I am chagrined that nobody has
ever tried to identify this waste - by patients. There are
disease-specific estimates for cost of noncompliance for total
population, but there almost seems to be reluctance to know how much
waste is patient-induced in Federal programs. They have worked the
provider fraud to death, but nothing on patient responsibility. I had
hoped for a federal grant to do such a study, but I do not trust my
humble efforts to see what has already been done. I would find
acceptable any statistically significant study that identified this
combined expense from patient waste. There should include the good
estimates of expense due to social abuses like smoking, drugs, alcohol
and obesity. Maybe I can't expect such research from this site, but I
was intrigued by the possibility and I hope this clarifies my needs. I
have also considered writing a book on the subject and would need data
if I cannot get a grant to study it myself. Feel free to ask for more
specifics - or to decline.